Medication & Weight Gain

Hi there,

As somebody with the crippling fear of gaining weight, I have heard lots of stories of people on various medications (Zyprexa, Seroquel, Abilify etc.) that claim they have packed on the pounds from these. Is there a particular science behind this? Is there any way to avoid this? As someone who plans on going on medication soon I am quite worried about this.

Thank you.

Not all medications cause weight gain, and some are worse than others. The first med I tried was Seroquel and at the time I was on my high school XC team and running 5-10 miles a day and eating pretty healthily. Despite that I still gained about 20 pounds in 6 months. Now that I'm not quite as active (but still working out and trying to eat healthily), on Zyprexa, Depakote, AND Invega, I'm gaining unbelievably fast and I honestly don't know how to stop it without quitting my meds or just stopping eating altogether (which isn't healthy either).
There are plenty of meds though that don't affect weight too much, or affect it less than, say, Zyprexa. Some of them are Geodon, Lamictal, Rexulti, Latuda, and even abilify isn't too bad for a lot of people. And not everyone gets every side effect, so you might get lucky with whatever your doc puts you on even if weight gain is a listed side effect. Of course having a healthy diet and being active will help a lot with slowing down the weight gain and keeping your energy levels up.

second that: every med affects everyone differently. Abilify was not a weight gainer for me at all, but Depakote made me gain 15 pounds in 3 months. I craved huge amounts of carbs everyday. All day long. Needless to say I told my Dr I couldn't take it anymore and we switched my mood stabilizer. Lamictal has zero side effects for me, though the common knowledge is it's more of a mood booster/depression fighter and not as strong in the mood stabilizing department. But even then, it's different for everyone.

I've found for myself, what I eat and being aware of my appetite is the thing that matters most. I do light cardio at the gym (can't do heavy cardio or any more strength training due to injuries). But it's the eating that really got to me. Good luck!

pizzapay wrote:Hi there,

As somebody with the crippling fear of gaining weight, I have heard lots of stories of people on various medications (Zyprexa, Seroquel, Abilify etc.) that claim they have packed on the pounds from these. Is there a particular science behind this? Is there any way to avoid this? As someone who plans on going on medication soon I am quite worried about this.

Thank you.

Yes there is. Many (atypical) anti-psychotics hit the histamine (H1) receptor which is known to pack on the pounds (Zyprexa, Clozaril, and Seroquel were really bad in this regard). Many also hit the 5-HT2c serotonin receptor which is another avenue for weight gain. If you'll notice a lot of the AP's that have recently come on the market (within past 10 years) do not hit these receptors, or if they do, they do so "weakly." Abilify was the first AP that was a "partial" agonist to some of these receptors. Most of the AP's that have come out since then have copied Abilify in that regard.

The first gen AP's that were used back in the day (70's - 80's) do not cause much weight gain. However, they are really bad for giving you TD that never goes away. So it's sort of a pick your poison type of thing. I personally would rather risk some weight gain over having a movement disorder that is permanent.

From a scientific paper:

Multiple mechanisms have been proposed to explain the weight gain propensity of antipsychotics. Amount of weight gain varies with the type of antipsychotic and the individual patient characteristics. Most research has focused on clozapine and olanzapine, the two medications identified to cause the highest weight gain. The high likelihood of weight gain with these medications has been linked to their actions at serotonin 5-HT2A and 5-HT2C, dopamine D2 and D3, histamine H1 and muscarinic M3 receptors.15 The differential effects on weight have been explained by the differing affinity of medications at these receptors.16,17

So it seems it is a multitude of receptors that are involved here. One receptor might increase hunger hormones like leptin. Others might actually slow the metabolic rate or increase triglycerides in the blood.

How to avoid it? Ask your shrink for an AP that is weight neutral or at least one where a small number of people gain lots of weight. The clinical trials of the drugs usually define a 7% gain in body weight to be significant. Many of the newer drugs cause 7% gain in like 10% or less of trial participants.

Ask your Doc about Latuda. It has been FDA registered for bipolar depression (but not mania). Rexulti is another one but it has not been FDA cleared for anything relating to bipolar. However, my shrink put me on it and I have bipolar. Vraylar is another newer one that has been FDA cleared for bipolar mania and depression I believe. Lots of people love it.

So, yeah. Ask him/her about those three.